Comprehensive Analysis of Early-onset Colorectal Cancer: A Review

Development and validation of predictive nomograms for survival in early-onset colon cancer patients with II-III stage across various tumor sites

Background

The incidence of colorectal cancer (CRC) has been escalating, with a concurrent rise in early-onset colon cancer (EOCC). Despite this alarming trend, the prognosis of EOCC has been understudied. Our study aims to identify risk factors associated with EOCC and develop nomograms for predicting overall survival (OS) and cancer-specific survival (CSS), with the goal of choosing suitable therapy for various patient subgroups.

Methods

Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database, we conducted a comprehensive analysis to elucidate risk factors in EOCC patients. We developed and validated nomograms to predict OS and CSS, stratifying patients into left-sided and right-sided groups and further categorizing them into distinct risk categories. After propensity score matching, we assessed therapeutic benefits of various interventions across subgroups.

Results

We identified T stage, tumor histology, grade, size, N stage, carcinoembryonic antigen (CEA) levels, perineural invasion, tumor deposits, and race as independent risk factors for the left-sided group through univariate and multivariate Cox regression analyses. Those factors were integrated into the survival nomograms for this group. For the right-sided group, tumor histology, grade, N stage, CEA levels, perineural invasion, tumor deposits, radiation, and chemotherapy were identified as independent prognostic factors and were similarly incorporated into the survival nomograms. The concordance index (C-index) for our nomograms was significantly higher than that of the American Joint Committee on Cancer (AJCC) 7th edition staging system across all cohorts. Receiver operating characteristic (ROC) curve analysis demonstrated area under the curve (AUC) values of 0.72, 0.71, and 0.71 for 1-, 3-, and 5-year OS in the development cohort of the left-sided group, with comparable results in the validation cohort. The right-sided groups exhibited similarly favorable AUC outcomes. Calibration plots indicated a strong correlation between predicted and actual outcomes. Decision curve analysis (DCA) revealed the clinical utility of our nomograms to be superior to the AJCC 7th edition staging system. Analyses for CSS yielded analogous results. Kaplan-Meier curves highlighted significant differences in OS and CSS between low and high-risk groups. Notably, the right-sided groups derived greater benefits from adjuvant chemotherapy compared to the left-sided groups, whereas radiation therapy provided no discernible benefits across all subgroups.

Conclusions

Our study provides a comprehensive prognostic evaluation of EOCC patients and uses nomograms for predicting OS and CSS in left-sided and right-sided groups. Subgroup analyses underscore the potential advantages of adjuvant chemotherapy in high-risk groups of both cohorts and the low-risk group of the right-sided cohort. These findings may inform the optimization of therapeutic strategies for EOCC patients.

Risk of Infertility in Reproductive-Age Patients With Thyroid Cancer Receiving or Not Receiving 131I Treatment: A Nationwide Population-Based Cohort Study

BACKGROUND

Fertility is the crucial concern for many survivors of cancer diagnosed as children, adolescents, and young adults. The objective of this study was to determine the risk of infertility in reproductive-age patients with thyroid cancer receiving or not receiving radioiodine treatment in Taiwan.

METHODS

This nationwide population-based cohort study was conducted using data obtained from the Taiwan National Health Insurance Database from 2009 to 2019. A total of 20,259 thyroid cancer patients aged from 15 to 50 years (8037 did not receive 131I treatment, and 12,222 received 131I treatment) and 20,259 controls were enrolled. A Cox proportional hazards model was applied to estimate the risk of infertility in thyroid cancer patients receiving or not receiving 131I treatment in terms of hazard ratios and 95% confidence intervals.

RESULTS

The incidence rates of infertility in thyroid cancer receiving 131I therapy, those not receiving 131I therapy, and controls were 5.55, 5.07, and 3.61 per 1000 person-years, respectively. Compared with thyroid cancer patients treated with a cumulative 131I dose of 4.44 GBq or less, the risk of infertility was not significantly increased in those treated with a cumulative 131I dose of more than 4.44 GBq (adjusted hazard ratio, 1.13; 95% confidence interval, 0.95-1.36).

CONCLUSIONS

The greatest increased risk of infertility in reproductive-age patients with thyroid cancer is associated with the fact that the patient has thyroid cancer regardless of 131I administration. 131I treatment or cumulative dose of 131I greater than 4.44 GBq did not further increase the risk of infertility.

Quantifying the Diagnosis and Survival of Early Onset Bowel Cancer Among First Nations Peoples in Queensland, Australia

INTRODUCTION

The incidence of early-onset bowel cancer (EOBC) is increasing in Australia and globally. However, the burden of EOBC among First Nations Australians is rarely determined. This study aimed to quantify the diagnosis and survival rates of EOBC among First Nations Peoples in Queensland, Australia.

METHODS

CancerCostMod, a linked administrative dataset of patients diagnosed with cancer in Queensland from 1st July 2011 to 30th June 2015, was used. EOBC was defined as a diagnosis of bowel cancer (i.e., colon, rectosigmoid, or rectal cancer) at 18-49 years of age. A multivariable logistic regression analysis was employed to determine the association of Indigenous status and other factors with a diagnosis of EOBC. Five-year survival rates were used to estimate the survival rate.

RESULTS

Of 11,702 bowel cancer cases, 9.2% (95% CI: 8.7%-9.7%) were EOBC, with 19% among First Nations peoples and 9% among Non-First Nations. First Nations Australians had 2.6 times the odds of EOBC diagnosis (95% CI: 1.7-4.0) compared with Non-First Nations Australians. Overall, EOBC patients showed a significantly higher 5-year survival rate of 77% compared with 60% for late-onset bowel cancer patients. However, First Nations EOBC patients showed a lower 5-year survival rate (73%) than Non-First Nations EOBC patients (77%).

CONCLUSION

First Nations Australians have more than double the diagnosis rates and lower 5-year survival for EOBC compared to Non-First Nations. Whilst the recent lowering of the age eligibility for the National Bowel Cancer Screening Program is a beneficial strategy to address the increasing incidence of EOBC, special consideration should be given to addressing the higher diagnosis rates and lower survival among First Nations Australians. This study raises the potential for further lowering the age eligibility for First Nations Australians to ensure younger First Nations Australians can access screening for earlier detection, thereby improving their survival from bowel cancer.

Prognostic Differences Between Early-Onset and Late-Onset Colorectal Cancer

Background and Objectives: Early-onset colorectal cancer (EO-CRC) has become a significant public health concern due to its alarming rise in incidence and the poor prognosis associated with this disease. The aim of our study was to identify epidemiological, clinical, and paraclinical characteristics that could explain the more aggressive evolution of EO-CRC compared to late-onset colorectal cancer (LO-CRC). Materials and Methods: We conducted a retrospective study over a two-year period, including 204 patients diagnosed with colorectal cancer (CRC). The patients were divided into two subgroups: those with EO-CRC and those with LO-CRC. Statistical analysis was performed using IBM SPSS Statistics, Version 29.0. Results: EO-CRC was identified in 11.3% of the patients included in the study. Compared to LO-CRC patients, EO-CRC patients exhibited a tendency for more distal tumor localization and a stenotic endoscopic appearance (43.5% vs. 29.3%). Regarding histopathological diagnosis, EO-CRC patients demonstrated a higher proportion of the mucinous histologic subtype (34.8% vs. 14.4%) and a significantly greater percentage of poorly differentiated tumors (39.1% vs. 14.5%; p = 0.010). Immunohistochemical results, available for a limited number of patients, revealed higher CDX2 positivity in LO-CRC patients (p = 0.012) and higher HER2 positivity in EO-CRC patients (p = 0.002). Smoking (p = 0.006) and hypertension (p = 0.002) were more prevalent in EO-CRC patients than in LO-CRC patients. Conclusions: Patients with EO-CRC exhibit distinct histopathological and molecular characteristics compared to those with LO-CRC, which may contribute to their poorer prognoses. The higher prevalence of the mucinous histological subtype, poor tumor differentiation, increased HER2 expression, and reduced CDX2 expression suggest potential molecular pathways driving the aggressive nature of EO-CRC. These findings highlight the need for tailored screening strategies and personalized therapeutic approaches in younger CRC patients. Future studies should further investigate the underlying mechanisms and potential biomarkers that could guide early diagnoses and targeted treatments.

PRKN-mediated the ubiquitination of IQGAP3 regulates cell growth, metastasis and ferroptosis in early-onset colorectal cancer

High IQ motif-containing GTPase activating protein 3 (IQGAP3) expression is considered to be associated with poor prognosis of colorectal cancer (CRC). However, its role in early-onset CRC (EOCRC) progress is unclear. The mRNA and protein levels of IQGAP3 and Parkin (PRKN) were examined by qRT-PCR and western blot. Cell proliferation, apoptosis and metastasis were determined by CCK8 assay, EdU assay, flow cytometry and transwell assay. ROS, MDA, GSH, Fe2+, ACSL4 and SLC7A11 levels were detected to assess cell ferroptosis. The interaction between PRKN and IQGAP3 was assessed by Co-IP assay and ubiquitination assay. Xenograft tumor models were constructed to explore the effect of PRKN and IQGAP3 on the tumorigenesis in vivo. IQGAP3 was upregulated, while PRKN was downregulated in EOCRC tissues and cells. IQGAP3 knockdown inhibited CRC cell proliferation, migration and invasion, while enhanced apoptosis and ferroptosis. PRKN ubiquitinated IQGAP3 to promote its degradation. PRKN overexpression suppressed CRC cell growth, metastasis and promoted ferroptosis, while these effects were reversed by upregulating IQGAP3. In animal study, upregulation of PRKN reduced CRC tumorigenesis by decreasing IQGAP3 expression in vivo. IQGAP3, ubiquitinated by PRKN, promoted EOCRC progression by enhancing cell proliferation, metastasis, repressing apoptosis and ferroptosis, which provided a novel target for EOCRC treatment.

Sex differences in survival outcomes of early-onset colorectal cancer

Colorectal cancer (CRC) is one of the most fatal cancers in the United States. Although the overall incidence and mortality rates are declining, an alarming rise in early-onset colorectal cancer (EOCRC), defined as CRC diagnosis in patients aged < 50 years, was previously reported. Our study focuses on analyzing sex-specific differences in survival among EOCRC patients and comparing sex-specific predictors of survival in both males and females in the United States. We retrieved and utilized data from the Surveillance, Epidemiology, and End Results (SEER) program. EOCRC patients, between the ages of 20 and 49, were exclusively included. We conducted thorough survival analyses using Kaplan-Meier curves, log-rank tests, Cox regression models, and propensity score matching to control for potential biases. Our study included 58,667 EOCRC patients (27,662 females, 31,005 males) diagnosed between 2000 and 2017. The baseline characteristics at the time of diagnosis were significantly heterogeneous between males and females. Males exhibited significantly worse overall survival (OS), cancer-specific survival (CSS), and noncancer-specific survival (NCSS) in comparison to females in both the general cohort, and the matched cohort. Predictors of survival outcomes generally followed a similar pattern in both sexes except for minor differences. In conclusion, we identified sex as an independent prognostic factor of EOCRC, suggesting disparities in survival between sexes. Further understanding of the epidemiological and genetic bases of these differences could facilitate targeted, personalized therapeutic approaches for EOCRC.

#CRCandMe: results of a pre-post quasi-experimental study of a mass media campaign to increase early-onset colorectal cancer awareness in Utah and Wisconsin

Overall colorectal cancer (CRC) incidence and mortality have been decreasing for several decades; however, since the early 1990s CRC incidence rates have nearly doubled among adults aged under 50 years. This study pilot-tested a community-based mass-media campaign aimed at improving knowledge and awareness of early-onset CRC in this population. The campaign (#CRCandMe) was deployed from June to September 2023 in Utah and Wisconsin. To evaluate its success (reach) and inform future campaigns, key performance indicators were defined (e.g., impressions, website traffic). To evaluate change in knowledge in the target population, the knowledge and awareness of participants recruited via consumer panels was assessed at baseline (n=235) and follow-up (n=161). The number of correct answers for each of seven knowledge items was calculated at baseline (pre-intervention) and follow-up (post-intervention). McNemar's test was employed to assess significant differences in the seven knowledge items between the two timepoints. The campaign delivered over 26.7 million impressions and nearly 43,000 clicks. A 15-second video ad received 221,985 plays, with 57,270 users watching to completion. Pre-survey results revealed that while 74% of participants were able to correctly identify CRC signs, only 18% could identify risk factors. Knowledge scores slightly improved from baseline to follow-up, with statistically significance for the question related to CRC signs (P=0.0004). This study demonstrated wide reach and may inform future larger-scale interventions and public health initiatives aimed at reducing CRC incidence and improving health outcomes for at-risk adults aged under 50 years.

Diagnostic and prognostic significance of ALU-based cell-free DNA in colorectal cancer: a systematic review and meta-analysis

Introduction

Colorectal cancer (CRC) is a major global health concern. This study aimed to investigate the role of ALU-based cell-free DNA (cfDNA) in the diagnosis and prognosis of CRC.

Methods

We selected relevant literature from PubMed, Scopus, Web of Science, EMBASE, and Science Direct databases based on strict inclusion and exclusion criteria. 17 eligible studies were included in the final analysis (13 studies for diagnostic and 4 studies for prognostic meta-analysis). The search covered relevant publications up to July 1, 2024.

Results

The pooled sensitivity, specificity, and diagnostic odds ratios (DOR) of ALU-based cfDNA in CRC diagnosis were 0.81 (95% CI= [0.70, 0.89]), 0.90 (95% CI= [0.70, 0.96]), and 40.58 (95% CI= [17.87, 92.19]), respectively. The area under the ROC curve was 0.92 (95% CI= [0.89, 0.94]). Patients with higher concentrations of plasma/serum ALU-based cfDNA had poorer overall survival (OS) (pooled hazard ratio = 2.33 ([95% CI= [1.80, 3.03]).

Conclusion

The current evidence supports the utility of circulating ALU as a promising non-invasive diagnostic and prognostic tool for CRC. Furthermore, as a potential biomarker, ALU-based cfDNA could play a significant role in clinical application.

Clinical implications

The evidence suggests that circulating ALU-based cell-free DNA (cfDNA) holds promise as a non-invasive diagnostic and prognostic tool for colorectal cancer, potentially enhancing clinical decision-making.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42023486369).